Crows Feet

Dimitrije E. Panfilov

Lateral to the canthus there are often radially spread wrinkles, especially if the patient smiles. It is possible to reduce these "smiling" wrinkles by Botox injections - temporarily. For permanent removal, there is a possibility to treat them from outside through epidermal ablation with laser resurfacing or radiosurgi-cal, chemical, or mechanical peel (dermabrasion).

Bruce Connell has shown that we can mark these smiling wrinkles on the skin and by doing the facelift surgery we remove these wrinkles caused by the lateral fibres of orbicularis oculi muscle - theses are the cutaneous attachments of this muscle, and we can seal them with radiofrequency treatment, which does not produce overheating like a laser or electrocautery. This is very important because the frontal branch of the facial nerve underlies these muscle fibres and could be terminally damaged.

Fig. 35.1. a Smiling patient before CO2 laser resurfacing. b Immediately after the procedure
Fig. 35.3. a Sterile markings over cutaneous attachments of the orbicularis oculi muscle. b Muscle attachments destroyed and sealed by radiofrequency treatment. Another patient c before and d after such treatment


Please see the general bibliography at the end of this book.

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